Provider Demographics
NPI:1114574779
Name:LINGENFELTER, MARIE ANNE (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:ANNE
Last Name:LINGENFELTER
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:661 MAHONING AVE NW
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-4607
Mailing Address - Country:US
Mailing Address - Phone:330-399-4243
Mailing Address - Fax:330-399-8716
Practice Address - Street 1:661 MAHONING AVE NW
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-4607
Practice Address - Country:US
Practice Address - Phone:330-399-4243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-19
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH371196163W00000X
OH201914503363LP0200X
OHAPRN.CNP.025612363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics